Order a Refill and/or a New Prescription:

We highly recommend that our clients order their prescriptions 3-4 weeks prior to the expiration of their current medication to ensure a constant supply.

Norphar.com Refill/New Prescription Form

All fields must be completed unless otherwise noted.

1. Enter your personal details

First Name

Middle Name

Last Name

Phone (Home)

Phone (Work)

(optional)

Phone (Cell)

(optional)

Fax

(optional)

2. If it has changed: Enter any new shipping information

Street
City/Town
State
Zip Code
Country

Also, please provide any additional shipping information. If you wish to have your order combined with a family member to save on shipping, please note here.

3. Enter the medications you wish to refill


Drug Name	Strength	Directions for use	Quantity Requested

Example Drug	12mg	1 tablet a day	90 pills

Note: It is generally cheaper to get a 90-day supply. You will get 1 delivery charge instead of 3 and you will receive the benefit of volume discounts on most medications.
Refills should be delivered in approximately 10 to 14 days.

4. Read our return policy

All sales are final. Be sure you order accurately to prevent problems. The law states:

"A pharmacist shall not accept for return to inventory any drug that has been previously dispensed"
Pharmaceutical Act Section 23(1) Return Medication (1)

I have read and understand the information above: Yes No

5. If it has changed: Enter new credit card Information:

Cardholder's Name

Credit Card Type

Credit Card Number

For Mastercard only, please enter three-digit security code from back of card. Example: xxxxxx xxx

Expiration date:

Month Year

Billing Address:
If different than shipping address

For Associates Only: ID#